Hypertension Flashcards
BP =
CO x HR
Angiotensin II
Vasoconstricts and controls aldosterone release
= Increased blood volume and BP
Aldosterone
Causes kidneys to reabsorb sodium and inhibit fluid loss
= Increased blood volume and BP
Risks associated with HTN
Heart attack, heart failure, stroke, and kidney disease.
Until age 50, ___ is a more potent RF.
DBP
After age 50, ___ is a more potent RF.
SBP
Coarctation of the aorta
= Narrowing of the aorta.
When this occurs, the heart must pump harder to force blood through the narrow part of the aorta.
= Cause of HTN
Obstructive uropathy
Structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy).
= Cause of HTN
Pheochromocytoma
A rare, catecholamine-secreting tumor that may precipitate life-threatening hypertension.
= Cause of HTN
Primary aldosteronism
One of the more common causes of secondaryHTN
Normal BP (JNC 7)
SBP <120, and DBP < 80.
Prehypertension (JNC 7)
SBP 120 – 139 or DBP 80 – 89.
Recheck in 1 year.
Stage 1 HTN (JNC 7)
SBP 140 – 159 or DBP 90 – 99.
Confirm within 2 months.
Stage 2 HTN (JNC 7)
SBP ≥ 160 or DBP ≥ 100.
Evaluate or refer within 1 month. If > 180/110 evaluate and treat immediately or within 1 week.
Thiazide/Thiazide-like Diuretic
MOA:
Excrete Na
Leads to PVR reduction
Contraindications:
Anuria
Renal decompensation
Hypersensitivity to thiazides or sulfonamides
Adverse events:
Potential for negative impact on dislipidemia, glucose control
Monitor for Na+, K+, Mg+ depletion
Elevated calcium, uric acid, glucose, cholesterol
Beta-adrenergic antagonists (BB)
MOA:
β-1 receptors (heart & kidneys) – stimulating effect
β-2 receptors (lungs, liver, pancreas, arteriolar smooth muscle) – relaxing effect
Cardioselective bind specifically to β-1 receptors
Non-cardioselective bind to β-1 and β-2 receptors
Adverse events:
Use with caution in untreated heart block
May cause bronchospasm
May worsen insulin resistance
May mask hypoglycemia
With discontinuation: taper over 10-14 days
Alpha-beta adrenergic antagonist
Carvedilol, labetalol MOA: Block adrenergic β-1, β-2, alpha-1 receptor sites, blunt catecholamine response Adverse events: Use with caution in untreated heart block May cause bronchospasm May worsen insulin resistance Less insulin resistance compared to BB Taper over 10-14 days
Carvedilol (Coreg)
Potent antihypertensive agent with a dual mechanism of action.
At relatively low concentrations it is a competitive beta-antagonist and a vasodilator, whereas at higher concentrations it is also a calcium channel antagonist. Potent competitive antagonist of beta 1- and beta 2-adrenoceptors. Carvedilol is also a potent alpha 1-adrenoceptor antagonist, which accounts for most of the vasodilating response produced by the compound.
Angiotensin-converting enzyme inhibitors (ACEI)
"-pril" suffix Mechanism of Action: Inhibit Angiotensin Converting Enzyme Decreases conversion of Ang I to Ang II (potent vasoconstrictor). Contraindications: Renal artery stenosis History of angioedema Pregnancy category D Adverse Events: Chronic dry cough, rashes, dizziness Hyperkalemia Angioedema, laryngeal edema
Angiotensin II Receptor Blockers (ARB)
"-sartan" suffix (eg. losartan, telmisartan) MOA: Selectively bind to Ang II receptors Block vasoconstricting and aldosterone-secreting effects of Ang II Contraindications: Pregnancy category D Angioedema Impaired kidney or liver function Adverse Events: Cough, fatigue, diarrhea, respiratory tract infections Hyperkalemia Angioedema
Renin Inhibitors
Aliskiren (Tekturna) Mechanism of Action: Blocks conversion of Angiotensinogin to Ang I Contraindications: Pregnancy Adverse Events: Diarrhea Angioedema
DHP Calcium channel blockers
The most smooth muscle selective class of CCBs are the dihydropyridines. Used to treat hypertension.
“-ipine” suffix (eg. amlodipine, felodipine)
MOA:
Inhibit movement of calcium across cell membranes
Decrease contractility of myocardial and smooth muscle
Contraindications:
Heart failure
Adverse Events:
Headache, flushing, palpitations, peripheral edema
NonDHP Calcium channel blockers
Non-dihydropyridines, comprise the other two classes of CCBs. Diltiazem, verapamil Mechanism of Action: Slows conduction at AV node Slows heart rate Contraindications: Heart failure Adverse Events: Peripheral edema Bradycardia AV block Constipation
Aldosterone antagonist
Spironolactone, Eplerenone MOA: Block effects of aldosterone Better regulation of Na+ & water Better maintenance of intravascular volume Adverse events: Hyperkalemia Gynecomastia with prolonged use Caution in renal impairment
